Surveys indicate that approximately nine percent of all pregnant women in New Haven, and 49 percent of prenatal clinic patients, use cocaine during pregnancy. Although many medical, drug treatment and social service resources are available, treatment efforts have been handicapped by a lack of 1) coordinated outreach, identification, intervention and treatment, 2) intensive treatment services, such as family support/case management or day treatment, and 3) knowledge about the optimal approach to service delivery for pregnant substance abusers. We are proposing to develop drug abuse treatment services in the major hospital-based prenatal clinic in New Haven We will evaluate all pregnant women for drug use and enroll cocaine dependent or abusing pregnant women in a randomized controlled treatment study comparing the effectiveness of two treatment protocols: a weekly drug treatment (WDT) group provided in the prenatal clinic; and a centralized, drug treatment program that provides family support services (CDPT/FSS). We will continue to offer treatment to women in the study for six months postpartum. We will compare the impact of the two treatments on prenatal an postpartum maternal substance use and AIDS risk behaviors; utilization of prenatal obstetrical services; rates of obstetrical problems; and health, neurobehavioral adaptation and development of child at birth and through th first six months of life.